A relevância social da educação para a saúde
Social relevance of health education
XI Jornadas APDIS
A informação em saúde ao serviço do cidadão
Isabel Loureiro
[email protected])
Lisboa, 28 de março 2014
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CONCEPTS
Alfabetização and literacia
• Alfabetização (Literacy training) – traduz o ato de
ensinar e aprender (a leitura, a escrita e o cálculo).
• Literacia (Literacy) – traduz a capacidade de usar as
competências (ensinadas e aprendidas) de leitura,
de escrita e de cálculo na vida quotidiana. (Benavente,
coord., 1996, p.13)
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Literacy levels...
• ...literacy levels, which are usually, but not
always, related to levels of education, are
important predictors of employement, active
participation in the community and health
status. They are also important predictors of
the success of a nation.
(Health Canada, 1999)
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How does health literacy differ
from literacy?
Literacy refers to basic skills needed to
succeed in society, while health literacy
requires some additional skills, including
those necessary for finding, evaluating and
integrating health information from a variety
of contexts. It also requires some knowledge
of health‐related vocabulary as well as the
culture of the health system.
(Rootman, I. , 2009. Presentation at the University of Victoria, BC. )
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Why literacy matters?
“Sometimes the problem is not health literacy, but the ability
to read or write at all”
Cheryl Rowan, 2013, http://nnlm.gov/training/healthliteracy/
95
Millions of adults
100
90
63
80
70
60
50
40
28
30
30
20
10
0
Below basic
Basic
Intermediate
Proficient
• Average reading level in the U.S. is 8th grade. 20% read at 5th grade level or below
(NAAL, 2003)
How to define health literacy?
• Translating Health Literacy :
o alfabetizacion en salud (Spain),
o alphabetisme en matière de santé (French),
o alfabetizzazione sanitaria (Italy)
Source: (Sorensen et al, 2013, p.58)
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Literacy
Definition – the capacities of processing written
information in daily life.
(Montigny et al, 1991, In: Benavente (coord.), 1996, p.4)
The concept of literacy appears under 2 perspectives:
• 1- the ability to read and write
• 2- having knowledge or competence, thus
displaying advanced education
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Health
• WHO definition of health, formulated in 1948,
describes health as “a state of complete physical,
mental and social well-being and not merely the
absence of disease or infirmity.”(WHO, 2006)
• …changing the emphasis towards the ability to
adapt and self manage in the face of social,
physical, and emotional challenges,…a group of
experts propose the formulation of health as the
ability to adapt and to self manage.(Hubber, et al, 2011).
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What is Health Literacy?
“The degree to which individuals have the capacity to obtain,
process, and understand basic health information and
services needed to make appropriate health care decisions”
(Ratzan, S., and R. Parker. (2000) In: Healthy People 2010 and Healthy People 2020; In:
IOM - Health Literacy: A Prescription to End Confusion, 2003)
“…the skills and competencies that all people develop to
seek out, comprehend, evaluate, communicate and use
health information and concepts to make informed choices.”
(Calgary Charter on Health Literacy, 2009)
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What is Health Literacy?
Health literacy implies the achievement of a level of
knowledge, personal skills and confidence to take action to
improve personal and community health by changing
personal lifestyles and living conditions. Thus, health literacy
means more than being able to read pamphlets and make
appointments. (Nutbeam, 1998, p. 264)
(WHO, Health promotion Glossary, 1998.
http://whqlibdoc.who.int/hq/1998/WHO_HPR_HEP_98.1.pdf)
http://www.healthliteracypromotion.com/Health-Literacy-Definitions.html
“The degree to which people are able to access, understand,
evaluate and communicate information to engage with the
demands of different health contexts in order to promote
and maintain good health across the life-course.”
(Kwan, B., Frankish, J., & Rootman, I. (2006)
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What is Health Literacy?
Health literacy is both a
means and outcome of
actions aimed at promoting
the
empowerment and
participation
of people
in their communities
and of people
in their health care.
(Zsuzsanna Jakab - Forward. Health
Literacy: the solid facts, WHO, 2013)
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Health literacy competencies
• Basic health competencies - health promoting, health
protecting and disease preventing behaviors, self‐care;
• Consumer competencies - health‐related decisions and use
of applicable goods and services and to act on consumer
rights if necessary;
• Patient competencies - navigate the health system and act
as an active partner to professionals;
• Citizen competencies through informed voting behaviours,
knowledge of health rights, advocacy for health issues and
membership of patient and health organizations.
(Kickbusch, I., Wait, S., Maag, D. Navigating health: the role of health literacy. (2005).
Retrieved from http://www.emhf.org/resource_images/NavigatingHealth_FINAL.pdf
(Kickbush e colaboradores, 2006)
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Integrated model of health literacy
(Sørensen et al. BMC Public Health 2012)
http://www.biomedcentral.com/1471-2458/12/80
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Health literacy levels in 8 EU countries
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Health literacy levels and self assessed
health status
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Why health literacy matters?
• Limited literacy is … a more powerful predictor of health
status than race or education (Volandes, Paasche-Orlow, 2007).
• Limited literacy is associated with limited participation in
health promotion and management of long term chronic
diseases (Rudd, Groene, Navarro-Rubio, 2013).
• Health is at risk when people cannot read or understand
medical information.
• Numerous studies document mismatch between patient
reading skills and the readability level of health materials.
• People deserve clear communication
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Poor health literacy and health costs
Adults with limited health literacy have…
•
•
•
•
•
•
•
Less knowledge of disease management
Less knowledge of health promoting behaviors
Report poorer health status
Less likely to use preventive services
Higher use of emergency services
Higher rate of hospitalizations
Inpatient spending is $993 higher than that of
persons with adequate health literacy.
Institute of Medicine, 2004
Potential for intervention points in the
health literacy framework
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Health
system
Health
outcomes
and costs
1
Culture
and
society
Health
literacy
Education
system
3
Fonte: IOM, 2003, p34
IOM – Health literacy: a prescription to end confusion. Washington: 2004
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Plain Language
• Crucial for promoting Health Literacy (Rudd, 2010)
• Language centered in the target population with a
readability level of 6 school years
An example from the USA:
http://www.plainlanguage.gov
• Promote the use of plain language for all government
communications
• Examples, word suggestions, thesaurus
• Separate section for health literacy
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Basic Tips for Message Content
•
•
•
•
•
•
•
Simple message
Lots of white space
Font type and size
Present tense and active verbs
No unnecessary words
Use “living room” language
Who is the audience?
Rowan, C. Promoting Health Literacy through Easy-to-Read Materials
http://www.nlm.nih.gov/medlineplus/etr.html
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Cultural Competency
• Tailor messages to intended
audience
• Avoid stereotypes
• Relevant photos/artwork
• Appropriate symbols
• Realistic recommended
behaviors
• Back-translate and field test
translated material
“…more than a patients’ rights issue…critical to safety and
quality of care”
Rowan, C. Promoting Health Literacy through Easy-to-Read Materials
http://www.nlm.nih.gov/medlineplus/etr.html
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All society engaged in health literacy
• Professionals must tailor their communication to
meet their patients’ needs
• Politicians must incorporate the notion and
paradigm of health literacy into their design of policy.
• Citizens must be able to make decisions about their
health for themselves
• Patients must be genuinely engaged and
empowered to participate in care decisions
(Adapted from: Kickbusch, Wait, & Maag. (2005). Navigating health: the role of health
literacy. Retrieved from
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http://www.emhf.org/resource_images/NavigatingHealth_FINAL.pdf)
Health services and health literacy
• Health literacy is also the responsability of the
health system and health services which
determines the parameters of the interaction,
namely physical space, time investment,
communication style, contents and attitudes
concerning information delivery.
Adams, 2010.
Health care model for chronic patients
Health care systems
Organization of health care
Community
Resources
and policies
Support to selfmanagement
Informed and
active patient
Health care
delivery model
Systems of clinical
Support to information
decision
Productive
interactions
Proactive and
ready local
health team
Better Results
Source: Wagner EH; Glasgow RE; Davis C et al (2001). Quality improvement in chronic illness care: a
collaborative approach.Jt Comm J Qual Improv. 27:63-80
10 attributes of a health literate organization
Kickbusch, I., Pelikan, J.M., Apfel & Tsouros, A. D. - Health literacy The solid facts. 2013
Typology of health literacy
(Nutbeam, 1998)
• Basic/functional literacy – sufficient basic skills in
reading and writing to be able to function effectively in
everyday situations
• Communicative/interactive literacy- more advanced
cognitive and literacy skills which together with social skills can
be used to actively participate in everyday activities...and to
apply new information to changing circunstances
• Critical literacy - critically analyse information and use this
information to exert greater control over life events and
situations
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Key partners for health literacy
(Mitic & Rootman, 2012)
• Governments – National and Municipal governments
• Health Sector – Health care providers including medical personnel,
health care institutions and clinics
• Education Sector – Public and private schools, adult literacy
programs, centers for continuing education
• Workplaces and Businesses – Small, medium and large
businesses and places of employment
• Community Organizations – Libraries, community recreation
centers, religious institutions, and the media. Immigrant settlement
services, family resource centers, women’s resource centers, unions
and senior support programs are other important examples. 28
Community organizations and
health literacy
• Developing knowledge
• Raising awareness and building capacity
• Building infrastructure and partnerships
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Determinants of Health
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•
•
•
•
•
•
•
•
•
•
•
Social status
Early life conditions
Income
Literacy Skills and policies
Nutrition
Employment Status
Education Level
Social support
Race or ethnic group
Social exclusion
Transportation
Stress
Source: Dahlgren and Whitehead, 1991
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CAPACITY
BUILDING
CAPACITIES
INFORMATION
EMPATHY
Interest
Perception of vulnerability
BELIEFS
NEEDS
Feelings/emotions
Knowledge
Afection
Information
NORMS
Choice/action
MOTIVATION
Leit motiv
BEHAVIOURS
FEELINGS
AUTONOMY
Sel-esteem or
frustration
SELF-EFFICACY
Support for
action
COMPETENCIES
- listening
VALUES
ATTITUDES
Management
Comprehension
Training
CULTURE
VALUES
-teaching
TIME
CATALISIS
PLACE
RESOURCES
ORGANIZATION
Adapted Loureiro, 2003
Health literacy is everyone’s business
… civic literacy skills involves
 advocating for policies and services for
maintaining and promoting one’s own health
 the health of family members and
 The health of the community
(Mitic & Rootman, 2012)
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Convention on the Rights of the Child
Art. 13th
1. The child shall have the right to freedom of expression; this right
shall include freedom to seek, receive and impart information and
ideas of all kinds, regardless of frontiers, either orally, in writing or
in print, in the form of art, or through any other media of the child's
choice.
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Convenção sobre os Direitos da Criança
Artº 24º
1- (…) Os Estados Partes reconhecem à
criança o direito a gozar do melhor estado
de saúde possível a beneficiar de serviços
médicos e de reeducação.
2-… e) Assegurar que todos os grupos da população,
nomeadamente os pais e as crianças, sejam informados,
tenham acesso e sejam apoiados na utilização de
conhecimentos básicos sobre a saúde e a nutrição da
criança, as vantagens do aleitamento materno, a higiene e a
salubridade do ambiente, bem como a prevenção de
acidentes;
f) Desenvolver os cuidados preventivos de saúde, os
conselhos aos pais e a educação sobre planeamento familiar
e os serviços respectivos.
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